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Feasibility Study of HIT-Enabled
PROMs in Home Health
Session 175, February 13, 2019
Cynthia Sun, MSN, RN & Gary Rezek, Quality Insights
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Cynthia Sun and Gary Rezek:
No real or apparent conflicts of interest to report
Conflict of Interest
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Background
Barrier / Solution
Study Description
Results
Conclusion
Considerations for Next Steps
Agenda
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Describe the feasibility of
integrating HIT-enabled Patient
Reported Outcome Measures
(PROMs) in the home health
setting
Explain three unique barriers and
possible solutions identified when
integrating HIT-enabled PROMs
in the home health setting
Discuss impact on home health
patients and clinician workflow
with the integration of HIT-
enabled PROMs
Learning Objectives
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Quality Insights
Offering health care quality solutions for systems, providers and
patients across the nation since 1973
Not-for-profit organization that measures and improves health and
health care quality through contracts with federal and state
agencies, foundations and private payers
More than 200 physicians, nurses, health services researchers,
statisticians, data analysts and educators bringing people and
information together to improve health
Headquartered in Charleston, West Virginia with offices in
Delaware, Pennsylvania, New Jersey and Virginia
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Background
Initial plan: Create evidence-based
patient and clinician resources to
improve the home health patient’s level
of self-efficacy
Barrier: No studies to date have examined using HIT-
enabled Patient Reported Outcomes (PROMs) in skilled
home health care
Solution: Study feasibility assessing practicality,
integration and acceptability (Bowen et al., (2009)) of
integration of HIT-enabled PROMs into the home health
setting
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Have you used PROMs?
1. Yes via HIT
2. Yes via paper & pencil
3. No, we’re planning to soon
4. Never heard of them
Polling Question
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PROMIS
®
Patient-Reported Outcomes
Measurement Information System
Validated person-centered measures
Multiple delivery formats
Customizable bank of over 300 patient-focused
health outcome measures
3 major domains (physical health, mental health
and social health) & Global health
www.nihpromis.org
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Method
Pilot Sites: Two home health agencies
Location: Pacific Northwest
Patient populations: Urban & Rural
Duration: Four months
IRB Approved
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Instrument
10 Apple iPads
PROMIS
®
app
Self-efficacy for managing symptoms (four items)
Self-efficacy for daily activities (four items)
Self-efficacy for managing medications and
treatments (four items)
Global health measures (10 items)
Airwatch’s Mobile Device Management (MDM)
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Clinician Training
Administer during scheduled
home visits
Answer only by patient
Inclusion criteria:
Alert
Willing
Able to read English
Repeat assessment in 2-4
weeks
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Feasibility Assessment
Combination of surveys,
interviews, and observations
Patients
Clinicians
Administrators
Information Technology (IT)
staff
Impact of tablet use on workflow
Barriers and facilitators of PROM-
data-collection using tablets
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# of elderly community-dwellers needing assistance by 2030
1. 1 million
2. 4 million
3. 12 million
4. 25 million
(Source: Bureau of Labor Statistics)
Polling Question
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Results
91 registered subjects with ages
ranging from 31 to 100 (mean 71.9,
median 74)
Eighty-four patients completed the initial
assessment of tablet-based PROM tool
Eight patients (9.5%) completed the
follow up assessment
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Results
64% of patients were female, 33% male
87% of patients were white and 92% non-
Hispanic
38% reported their level of education. Of
those patients 72% had at least a high
school education
Mean assessment completion time was 8.3
minutes (median time 6.1 minutes)
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Results
Relationship between assessment duration (in minutes) and
patient characteristics (N=84)
F
p
df
N*
Race
0.65
0.6917
6,70
71
Ethnicity
0.79
0.4593
2,68
69
Gender
0.00
0.9699
1,68
69
Education
1.37
0.2976
7,20
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Pearson's r
p
N*
Age
0.30313
0.0107
70
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Results
Distribution of primary diagnosis for patients who
participated in the study
Primary Dx group
Count
Examples of Diseases
Included
Orthopedic
42
Fracture(s); Muscle weakness; Aftercare following
joint replacement surgery
Cardiovascular
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Heart failure; Atrial fibrillation; Myocardial
Infarction; Hypertensive heart disease
Integumentary
8
Surgical wound dressings; Open wound; Pressure
ulcer
Urologic
5
Malignant neoplasm of bladder; Urinary tract
infection
Respiratory
6
Chronic obstructive pulmonary disease with (acute)
exacerbation; Pneumonia
Neurologic
3
Hemiplegia and hemiparesis following cerebral
infarction,
Diabetic neuropathy, Repeated falls
Other
4
Sepsis, Injury of head
N=81 (cases with non-missing diagnosis data)
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Results
Clinician feedback pointed to areas for improvement of usability
Preference for finger use rather than stylus
Sharing of tablets was a logistical hurdle
Suggestions for aesthetic enhancements to app
Technical aspects such as security, update message
popups, power saving settings could be disruptive
A perceived lack of clinical relevance (to the current clinical
process) led to low rate of repeat assessments
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Conclusion
HIT-enabled PROMs in the home health
setting is suitable for the workflow
No negative impact on goals of care
Tablets were found to be practical and
generally accepted by both home health
clinicians and patients
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Considerations
Patient functional capabilities at
the tool level of PROMIS
®
Ease of integration of app
collected data into existing EHR
Future research:
Test HIT enabled PROMs on
improvement of care quality
and outcomes
Test on a larger scale
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References
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Quality Insights: www.qualityinsights.org
Cynthia Sun: cksun@qualityinsights.org
Gary Rezek: grezek@qualityinsights.org
Please remember to complete the evaluations
Questions